Fentanyl: The Worst Is Yet To Come
On the Monday evening of February 28th, I made the last minute decision to drive to Los Angeles after work, a move that would ultimately save my older brother from death later that night. The next morning I was awoken by a phone call from Cedars Sinai Emergency Room in Marina Del Rey, he was cleared for release. I was there to pick him up at around 6am and waited in the parking lot. No visitors were allowed in. As he entered the car he asked what happened, he had no recollection of the past 4 hours. The tests run by the hospital came back negative. But I knew it had to be fentanyl and my suspicion was verified when he finally admitted he took a small blue pill before going to sleep.
That Tuesday morning as we drove west on Jefferson , through the Ballona Wetlands, I explained to him how I found him the night before. How quickly he went from choking to silent as I pushed him on his side and yelled his name in a desperate attempt to wake him. He was completely unresponsive. Body limp. I could smell vomit. And then he began to fade. A purplish grey. I watched as it spread to his ears, his breath slowing until it stopped. I couldn’t locate a heart beat.
In that moment time as I understood it also stopped.
I was faced with the potential reality that my brother was dead. Panic began to set in but almost as quickly as I felt it I denied it. I was not willing to lose him, not in front of his mother. Not like this. I refused to accept that version. So I pried open his mouth, moved his swollen tongue, and stuck my hand down his throat , hoping his body would eject whatever it was he had taken. Instead, his body took a quick deep gasp, but still no response. I yelled for my step-dad to call an ambulance while I kept my hand in his mouth, holding his tongue to the side, fearing that if I let it go he would stop breathing again. My mother crying, watching as her first born faded before her eyes. We were sitting on death’s door fighting against time to leave before it noticed us.
The ambulance arrived near instantly and even the EMT’s could not identify the source of the problem. They repeatedly stated that the symptoms pointed to an allergic reaction but he was not responding to the injections and we repeatedly told them he had no allergies. They affixed a bag-valve mask on his face to assist with breathing and carried him out in the gurney, still unconscious. While in the ambulance they administered Narcan and he finally came to.
My brother has a history of alcohol abuse and during a drunk induced lapse in judgement, he purchased what he thought was a painkiller from someone off the street in Hawthorne. What he got instead was a counterfeit M-30 pill cut with fentanyl. I warned him last year that buying drugs is now akin to playing Russian Roulette with a loaded gun, a phrase I picked up from my close friend and medical examiner investigator who has been dealing directly with the lifeless bodies. The unwitting victims of the deadliest drug epidemic in American history.
That morning after picking my brother up from the ER, we stopped at the pharmacy to drop his prescription for nausea medication, I then took a small nap and I logged on to work at 8am.
For many families and first responders alike this is fast becoming the new normal in America.
Deadliest drug epidemic in american history
The opioid epidemic started in the 90’s with the over-prescription of opioid pain relievers. Doctors who where assured by Purdue Pharma that their pills were non-addictive pushed opioids to their patients, sparking the widespread use and abuse. Once users could no longer procure renewed doctors prescriptions in 2010, the second wave of the opioid epidemic began as they turned to heroin and other substances to maintain their addiction and manage their pain.
Around 2013 illicitly manufactured fentanyl kicked off the third and current wave, or rather tsunami, of death that continues to ravage North America. Because fentanyl can be made in a laboratory, is not hindered by agricultural variables, and is extremely potent, producers are able to create more product relatively cheaply and increase their profits. This led to suppliers mixing heroin and other illicit substances with fentanyl, “a synthetic opioid 50 to 100 times more potent than morphine, as well as pressing it into counterfeit pills to mimic the look of mainstream prescription painkillers.” Nine years later, fentanyl has proven impossible to contain as it continues to spread across a wide demographic and socioeconomic spectrum.
In a letter sent to federal, state, and local law enforcement on April 6th, Anne Milgram, Administrator of the DEA states that:
Fentanyl is driving the nationwide overdose epidemic: the CDC estimates that in the 12 month period ending in October 2021, over 105,000 Americans died of drug overdoses and over 66% of those deaths were related to fentanyl and other synthetic opioids. Last year, the United States suffered more fentanyl related deaths than gun-related and auto-related deaths combined.
The letter goes on to address the rise in fentanyl-related mass-over dose events across the US. It details 7 events occurring in a two month span where groups of people overdosed from what they thought was either cocaine, 30mg oxycodone pills, or methamphetamine. The overdoses took place anywhere from homeless shelters, to apartments, and hotels throughout different states and highlighted the troubling fact that “many of the overdose victims …had no idea they were in fact ingesting fentanyl.”
But this is no longer only affecting those with substance abuse issues, the mentally ill who self medicate, or the homeless. Fentanyl is now increasingly killing teens, first time users who are experimenting with drugs and unknowingly taking fentanyl . A new study published on Tuesday, April 9th, in JAMA revealed a 94% increase in fatal overdoses from 2019 to 2020 and that of all teen deaths in 2021, 77% of them involved fentanyl.
‘ "For decades, we've seen overdose rates rising among adults, and teens have been insulated from that," says Friedman. "And now, for the first time, the overdose crisis is reaching teens as well." ‘
Joseph Friedman, lead author of the study and public health researcher at the University of California, Los Angeles believes that now is an especially important time to intervene, during the beginning stages of teen overdose. He warns that once death rates starts to rise, they tend to continue to do so for quite some time. Hinting at the horrific potentiality of fentanyl wiping out an entire generation.
Fentanyl supply chAIn
Despite scheduling fentanyl analogs in 2019 China remains the primary source of fentanyl in North America, though they deny it.
All “fentanyl-like substances” were made illegal but they did not criminalize all precursor chemicals. The two main fentanyl precursors, NPP and 4-ANPP, were already scheduled prior to the ban but “after 2019 marketing for at least four fentanyl precursor substitutes for NPP and 4-ANPP became increasingly common on the clear web. “ The class ban initially served as a deterrent but soon after Chinese vendors found a workaround by producing and selling substitute precursor chemicals used to make fentanyl that are not criminalized. All four of the substitutes were uncontrolled at the time in both United States and China and “included ‘masked’ precursors, or chemicals that are designed to disguise their relation to a scheduled substance, but from which scheduled precursors can be easily obtained.”
Vendors tapped into online networks to market their products, advertising openly on sites like Facebook and LinkedIn. They obtained customers through E-commerce websites and marketplaces but also have their own independent sites where they list available chemicals for sale. Social media facilitated the creation of client networks and directed traffic to these sites, allowing vendors to ship directly to customers in the U.S and to Mexican cartels. Vendors further adapted by eschewing the use of the word “fentanyl” and other recognizable terms opting instead for chemical nomenclature. By using CAS (Chemical Abstract Services) numbers or IUPAC (International Union of Pure and Applied Chemistry) names as identifiers they continued selling on the clear web without detection.
When China adopted stricter mail monitoring, vendors merely turned to yet another loophole: instead of shipping directly to the US via international mail carriers they shifted to smuggling large volumes of synthetic opioids within lawful bulk cargo. And now most smuggling takes place via Mexico. Cartels source fentanyl precursors — “and increasingly pre-precursors”— from China, finish producing it in clandestine labs, and then “traffic finished fentanyl from Mexico to the United States.” Vanda Felbab- Brown, senior Fellow at the Brookings Institute, references investigative research from C4ADS showing how Chinese sellers “bundle uncontrolled fentanyl and meth precursors and common cocaine fillers in their Spanish-language advertisements and highlight their capacities to ‘clear customs in Mexico.’ ”
China, however, maintains that they cannot take actions against these vendors because they are selling non-scheduled meth and fentanyl precursors, regardless of the fact that they openly sell to drug cartels. Sellers operate with the same mentality and have no qualms about selling substances to customers in countries where they are illegal. To Chinese sellers buyers are the ones responsible with ensuring the compound is legal wherever the receiver’s address is.
In an interview with Forbes about China’s growing involvement in Mexico’s organized crime, Felbab-Brown, an expert on international conflicts with extensive research and fieldwork on illicit economies and organized crimes, emphasizes that the Chinese government “rejects China’s responsibility for the smuggling of drug precursors into Mexico [and the US]. It insists that these problems are for the Mexican [and US] governments to solve.” She goes on to explain that in order to address this growing drug problem, scheduling was simply not enough, China must collaborate and be willing to share intelligence with Mexico and the United States and “up its interdiction operations” against sellers catering to Mexican cartels.
Meanwhile, in Mexico, cartel chemists are beginning to diversify and create their own precursor chemicals. In a National Geographic episode of “Trafficked with Mariana Van Zeller,” Van Zeller speaks to a Sinaloan chemist, a biochemical engineer by day, in his underground lab as he mixes the precursor chemicals with his ingredients, their own house recipe. Once finished the product is pressed into pills and stamped with the M on one side and the 30 on the other to create counterfeit blue m-30’s. The end product is indistinguishable from prescription Oxycodone pills and is ready to cross the border into California where it heads to a Los Angeles distribution center. Once there, native Angelenos working for the Sinoloan cartel transfer it to drivers headed to Oklahoma, Texas, and Atlanta. Van Zeller asks the masked distributor if he knows what he is helping to sell and he says he has no idea. He merely focuses on his task, his station in the supply chain, and does not ask any questions.
The Sinaloan chemist ends the episode by telling Van Zeller “You’ve seen what we can do in just a small room. Just imagine if we don’t have to order it from China…I can’t tell you how it’s processed but the raw materials we need are now being produced in Mexico.”
A frightening foreshadow of what lies ahead.